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A Review of Residential Radon Case-Control ... - Aarst.com

A Review of Residential Radon Case-Control ... - Aarst.com

158 R.W. FIELD When the

158 R.W. FIELD When the histologic type was limited to adenocarcinoma (p=0.04 for categorical analyses), a positive dose-response trend was suggested. In addition, the highest quintile of radon concentration was statistically significant for the adenocarcinoma subgroup (OR=1.66; 95% CI= 1.0–2.6). When the analyses were adjusted for saturated fat intake, both the categorical and the continuous trend tests for adenocarcinoma were statistically significant (p< 0.05). A suggestive positive dose-response trend was also noted in the analyses that were restricted to the live-case and live-control subset (p=0.06). Similar dose-response patterns were noted when cumulative dose estimates in the form of Working Level Months (WLM) were used in the analyses. Supplementary-related papers concerning the Missouri-I study are available elsewhere /28–34/. Missouri-II Residential Radon Study Alavanja et al. /21/ published the major findings from the Missouri-II Radon Study in 1999. The lung cancer cases comprised females between the ages of 30 and 84 years with primary lung cancer that were reported to the Missouri Cancer Registry between January 1993 and January 1994. In addition to the registry-reported primary lung cancer diagnosis, tissue slides were independently reviewed for all of the available cases. The controls were population-based and randomly selected from Missouri driver’s license files for women 30 and 64 old. Women between 65 and 84 years of age were randomly selected from Health Care Finance Administration files. The controls were matched by 5-year age groups to the case subjects. A 2-stage randomized recruitment method was used for controls to help increase the percent of smokers in the control group. All heavy smokers in the pool of potential controls were invited to participate. Sixty-two percent of the light smoking white women and twenty six percent of the former light smoking white women were invited to complete the entire interview. The corresponding percentages of nonwhite controls who were invited to complete the entire interview were 75% and 34%, respectively. Telephone interviews with subjects or proxy respondents collected information on residential history, lifetime smoking history, environmental tobacco exposure, education, and previous lung disease. A follow-up, face-to-face interview collected information on dietary factors, housing characteristics, and location of glass surfaces that were appropriate for placing retrospective radon detectors (also called RRDs or CR-39 surface monitors). Radon measurements were made to estimate the subjects’ exposures for the period 5 to 25 years before diagnosis for cases or for the period 5 to 25 years before interview for controls. Subjects who did not have at least 70% of the previous 25 years accounted for by either of two types of radon measurements (see below) were excluded from the study. In total, 512 case and 553 control subjects (Table 1) were included in the study. Thirty-two percent of the case respondents and zero percent of the control respondents were proxy respondents. The study incorporated two different radon dosimetry techniques. The first technique used ATDs similar to those used in Missouri I. Yearlong ATD measurements were made in the kitchen and bedroom of the home that was currently occupied by the study subject (Table 2). The other dosimetry technique used glass-based RRDs (retrospective radon detectors) /35–37/. The RRD utilizes the accumulation of a long-lived radon decay product, 210 Pb, in glass. As radon gas goes through its radioactive decay chain, it produces a decay product, 210 Pb, which has a very long half-life (around 22 years). A fraction of the 210 Pb implants in glass surfaces in a room, providing a long-lasting marker for retrospective radon concentrations. Lead-210, in turn, produces a shorter-lived decay product, 210 Po. The 210 Po

RESIDENTIAL RADON CASE-CONTROL STUDIES IN THE UNITED STATES 159 decay can be measured by the tracks it creates in a suitable piece of plastic by the emitted alpha particles. Over 70% of the homes had results of either the ATD or RRD measurement, which resulted in a 91% coverage for the 5- to 25-year period window. Information was not provided concerning the percent coverage by detector type or the percent of time that the subjects spent in the home. The respective mean radon gas ATD measurements for the current kitchen and bedroom were 58 and 56 m −3 . The geometric radon concentrations by level of the home are presented in Table 3. The respective mean RRD measurements for the kitchen and the bedroom were 65 and 65 Bq m −3 . Neither dosimetry technique produced a significant difference between the two rooms, so the authors used the mean radon concentration for the two rooms as their measure of radon exposure for each of the two procedures. The RRD measurements were performed on objects with average ages of 32 and 31 years for controls and cases, respectively. Time-weighted average radon gas exposures were estimated for the current home and assumed to be representative of the radon concentration existing in all homes during the period of interest. Annual time-weighted average radon exposures were also calculated by dividing the cumulative radon measurement results, obtained by RRDs, by the number of years the subject had owned the glass object. The respective mean radon gas measurements (obtained from ATDs) and glassbased measurements (obtained from RRDs) from controls were used to impute missing data for the air gas measurement and glass measurement techniques. The respective ORs for air measurements using ATDs, adjusted for age, education, previous lung disease, pack-years of smoking, and mean servings of vegetables per week for four categories of radon exposure (148 Bq m −3 ) were 1.00, 0.87, 0.91, and 0.71 (Table 4). The continuous trend in ORs with increasing radon concentration was not statistically significant (p=0.79). Alternatively, a significant lung cancer risk was noted for the analyses that were based on RRD glass-based measurements. The respective ORs based on 471 controls and 372 cases using RRD glass-based measurements, adjusted for age, education, previous lung disease, pack-years of smoking, and mean servings of vegetables per week, for the four categories of radon exposure (148 Bq m −3 ) were 1.00, 1.11, 1.32, and 3.33. The OR for the highest exposure category was also significant at the 95% confidence interval (Table 4). The continuous trend in ORs with increasing radon concentration was statistically significant (p=0.02). The doseresponse trend was similar for each histologic type. The authors performed an error analysis indicating that the discrepancy between air measurements and RRDs may have been due to increased random error for the indoor measurements relative to RRDs. Supplementary papers concerning the Missouri-II study are available elsewhere /38–41/. Iowa Residential Radon Study Field et al. /22/ published the major findings paper from the Iowa Radon Lung Cancer Study in 2000. The lung cancer cases were females aged 40 to 84 years having newly diagnosed, microscopically confirmed, primary lung cancer with no prior lung cancer. The cases were restricted to residents of Iowa who had been living in their current home for at least 20 years. The cases were identified (over 90% rapid reported) by the Iowa Cancer Registry between May 1993 and October 1996. In addition to the registry reported primary lung cancer diagnosis, 98% of the cases tissue slides were independently reviewed for histologic verification. The controls were population based and randomly selected from Iowa driver’s license files for women 30 and 64 years old. Women between 65 and 84 years of age were randomly

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